Dynamic positive end-expiratory pressure strategies using time and pressure recruitment at birth reduce early expression of lung injury in preterm lambs

Positive end-expiratory pressure (PEEP) is critical to the preterm lung at birth, but the optimal PEEP level remains uncertain. The objective of this study was to determine the effect of maximum PEEP levels at birth on the physiological and injury response in preterm lambs. Steroid-exposed preterm l...

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Bibliographic Details
Published in:American journal of physiology. Lung cellular and molecular physiology 2022-10, Vol.323 (4), p.L464-L472
Main Authors: Tingay, David G, Pereira-Fantini, Prue M, Miedema, Martijn, McCall, Karen E, Perkins, Elizabeth J, Dowse, Georgie, Schinckel, Nicholas, Sourial, Magdy, Davis, Peter G
Format: Article
Language:English
Subjects:
Animals
Animals, Newborn
Lung Injury
Positive-Pressure Respiration - methods
Respiration
Respiratory Mechanics - physiology
Sheep
Sheep, Domestic
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Summary:Positive end-expiratory pressure (PEEP) is critical to the preterm lung at birth, but the optimal PEEP level remains uncertain. The objective of this study was to determine the effect of maximum PEEP levels at birth on the physiological and injury response in preterm lambs. Steroid-exposed preterm lambs (124-127 days gestation; = 65) were randomly assigned from birth to either ) positive pressure ventilation (PPV) at 8 cmH O PEEP or 3-min dynamic stepwise PEEP strategy (DynPEEP), with either ) 20 cmH O maximum PEEP (10 PEEP second steps) or ) 14 cmH O maximum PEEP (20-s steps), all followed by standardized PPV for 90 min. Lung mechanics, gas exchange, regional ventilation and aeration (electrical impedance tomography), and histological and molecular measures of lung injury were compared between groups. Dynamic compliance was greatest using a maximum 20 cmH O (DynPEEP). There were no differences in gas exchange, end-expiratory volume, and ventilator requirements. Regional ventilation became more uniform with time following all PEEP strategies. For all groups, gene expression of markers of early lung injury was greater in the gravity nondependent lung, and inversely related to the magnitude of PEEP, being lowest in the 20 cmH O DynPEEP group overall. PEEP levels had no impact on lung injury in the dependent lung. Transient high maximum PEEP levels using dynamic PEEP strategies may confer more lung protection at birth.
ISSN:1040-0605
1522-1504
DOI:10.1152/ajplung.00047.2022